Cost, Reluctant Docs Keep Hospitals From Using Digital Records

Less than 2 percent of U.S. hospitals have fully switched to electronic health records, posing “substantial obstacles” to the Obama administration’s goal of making care more efficient, a Harvard-led study found.

Lack of money posed the main hurdle, according to almost three-quarters of the 3,000 hospitals surveyed for the study, appearing online today in the New England Journal of Medicine. About a third also cited reluctance among doctors to change their work habits, and just less than a third also said their staff lacked the technical skills.

Barack Obama pledged during his presidential campaign to spend a total of $50 billion over five years to help the U.S. health-care industry move into the computer age. His economic stimulus package, which Congress passed last month, provides $19.5 billion help with conversion, which Obama says will save money and improve quality. Most of those payments will start in 2011.

“We have a long way to go to achieve a health-care system that is fully electronic,” said author Ashish Jha, an associate professor at the Harvard University’s Harvard School of Public Health, in Boston, in an e-mail. “This is a big mountain to climb.”

One of the nine authors, Harvard professor David Blumenthal, was named March 20 to become national coordinator for health information technology, working at the Health and Human Services Department to oversee spending the $19.5 billion.

“The very low levels of adoption of electronic health records in U.S. hospitals suggest that policy makers face substantial obstacles to the achievement of health care performance goals that depend on health information technology,” according to the study.

‘Daunting’ Outlay

The U.S. had 5,700 hospitals in 2007, according the Web site of the American Hospital Association, the Chicago-based trade group whose members were surveyed. Setting up electronic health records can cost from a few million dollars for a small hospital to hundreds of millions for multihospital networks, a “daunting financial outlay,” said John Glaser, vice president of Partners HealthCare System, yesterday in a telephone interview.

Partners is a network of Boston-based health-care providers, including Brigham & Women’s Hospital, a teaching affiliate of Harvard Medical School. Glaser wasn’t listed among the authors.

More than three-quarters of U.S. hospitals have an electronic system in place to view the results of laboratory or radiology tests, the researchers said. Full implementation would encompass electronic note-taking for doctors and nurses, computerized services that help doctors make decisions, such as drug allergy alerts, and electronic prescriptions, the authors wrote.

Future Savings

The technology doesn’t show immediate savings, said Don May, a vice-president for policy at the American Hospital Association, in a telephone interview.

“There’s not just upfront capital, but ongoing maintenance, which also requires trained staff,” he said. The “stimulus funding is a good down-payment, but it’s going to take more to get there.”

About 12 percent of physicians use electronic systems, according to an estimate by the Congressional Budget Office, which provides independent analysis for lawmakers. The figures were in a 2008 statement from former director Peter Orszag, now the White House budget chief, in testimony to the Senate Finance Committee.

The Harvard-led survey was conducted from March through September of last year.

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